Your Child's Checkup: Newborn

What to Expect

In the hospital, the doctor and/or nurse will probably:

1. Check your baby's weight, length, and head circumference and plot the measurements on the growth charts.

2. Ask questions, address any concerns, and offer advice on taking care of your baby:

Feeding. Breast milk is the best form of nutrition for infants, but formula also can provide the nutrients they need. Newborns should be fed on demand (when they're hungry), which is about every 1 to 3 hours. Your doctor or nurse may watch as you breastfeed and offer help with any problems. Formula-fed newborns take about 1–1½ ounces (30–45 ml) at each feeding. Burp your baby midway through a feeding and at the end. As they grow, babies start to eat more at each feeding, so will need fewer feedings over time.

Peeing and pooping. A breastfed baby may have only one or two wet diapers a day until the mother's milk comes in. Expect about six wet diapers by 3–5 days of age for all babies. Newborns may have just one poopy diaper a day at first. Poop is dark and tarry the first few days, then becomes soft or loose and greenish-yellow by about 3–4 days. Newborns typically have several poopy diapers a day if breastfed and fewer if formula-fed.

Sleeping. A newborn may sleep up to 18 or 19 hours a day, waking up often (day and night) to breastfeed or take a bottle. Breastfed babies usually wake to eat every 1 to 3 hours, while formula-fed babies may sleep longer, waking every 2 to 4 hours to eat (formula takes longer to digest so babies feel fuller longer). Newborns should not sleep more than 4 hours between feedings until they have good weight gain, usually within the first few weeks. After that, it's OK if a baby sleeps for longer stretches.

Developing. Newborn babies should:

• pay attention to faces or bright objects 8–12 inches (20–30 cm) away
• respond to sound — they may turn to a parent's voice, quiet down, blink, startle, or cry
• hold arms and legs in a flexed position
• have strong newborn reflexes, such as:
  • rooting and sucking: turns toward, then sucks breast/bottle nipple
  • grasp: tightly grabs hold of a finger placed within the palm
  • fencer's pose: straightens arm when head is turned to that side and bends opposite arm
  • Moro reflex (startle response): throws out arms and legs, then curls them in when startled

3. Do a physical exam with your baby undressed while you are present. This will include an eye exam, listening to your baby's heart; feeling pulses; inspecting the umbilical cord; and checking the back, hips, and feet.

4. Do screening tests. Your baby's heel will be pricked for a small amount of blood to test for certain harmful diseases. Your baby should also get a hearing test and oxygen levels checked before leaving the hospital.

5. Give first immunizations. While in the hospital, your baby should have his or her first immunizations. Immunizations can protect infants from serious childhood illnesses, so it's important that your baby get them on time. Immunization schedules can vary, so talk to your doctor about what to expect.

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Looking Ahead

Here are some things to keep in mind until your baby's next routine checkup in a few days:

Feeding

1. If you breastfeed:
   • Help your baby latch on correctly: mouth opened wide, tongue down, with as much of the breast in the mouth as possible.
   • Don't use a bottle or pacifier until nursing is established (around 1 month).
   • Feed your baby when he or she is hungry. Pay attention to signs that your baby is full, such as turning away from the nipple and closing the mouth.
   • Continue to take a prenatal vitamin or multivitamin daily.
2. If you formula-feed:
   • Give your baby iron-fortified formula.
   • Follow the formula package's instructions when making and storing bottles.
   • Don't prop bottles or put your baby to bed with a bottle.
   • Pay attention to signs that your baby is full, such as turning away from the bottle and closing the mouth.

Routine Care

1. Wash your hands before handling the baby and avoid people who may be sick.
2. Hold your baby and be attentive to his or her needs. You can't spoil a newborn.
3. Keep the diaper below the umbilical cord so the stump can dry. The umbilical cord usually falls off in 10–14 days.
4. For circumcised boys, put petroleum jelly on the penis or diaper's front.
5. Girls may have vaginal discharge that may include a small amount of blood during the first week of life.
6. Give sponge baths until the umbilical cord falls off and a boy's circumcision heals. Make sure the water isn't too hot — test it with your wrist first.
7. Use fragrance-free soaps and lotions.
8. Call your baby's doctor if your infant has a fever, is acting sick, isn't eating, isn't peeing or pooping, isn't latching on or sucking well when nursing, doesn't seem satisfied after breastfeeding, looks yellow, or has increasing redness or pus around the umbilical cord or circumcision. Do not give any medicine without talking to the doctor first.
9. It's common for new moms to feel tired and overwhelmed at times. But if these feelings are intense, or you feel sad, moody, or anxious, call your doctor.
10. Talk to your doctor if you're worried about your living situation. Do you have the things that you need to take care of your baby? Do you have enough food, a safe place to live, and health insurance? Your doctor can tell you about community resources or refer you to a social worker.

Safety

1. To reduce the risk of sudden infant death syndrome (SIDS):
   • Breastfeed your baby.
   • Let your baby sleep in your room in a bassinet or crib next to the bed until your baby's first birthday, or for at least 6 months, when the risk of SIDS is highest.
   • Always place your baby to sleep on a firm mattress on his or her back in a crib or bassinet without any crib bumpers, blankets, quilts, pillows, or plush toys.
   • Avoid overheating by keeping the room temperature comfortable.
   • Don't overbundle your baby.
   • Consider putting your baby to sleep sucking on a pacifier. If you're breastfeeding, wait until breastfeeding is established before introducing the pacifier.
2. Don't smoke or use e-cigarettes. Don't let anyone smoke or vape around your baby.
3. Always put your baby in a rear-facing car seat in the back seat. Never leave your baby alone in a car.
4. While your baby is awake, don't leave your little one unattended, especially on high surfaces or in the bath.
5. Never shake your baby — it can cause bleeding in the brain and even death.
6. Avoid sun exposure by keeping your baby covered and in the shade when possible. Sunscreens are not recommended for infants younger than 6 months. However, you may use a small amount of sunscreen on an infant younger than 6 months if shade and clothing don't offer enough protection.

These checkup sheets are consistent with the American Academy of Pediatrics (AAP)/Bright Futures guidelines.